Violence and Trauma in the Lives of Women with Serious Mental Illness Often Overlooked

From Marina Morrow with the British Columbia Centre of Excellence for Women’s Health

A new study from the BC Centre of Excellence for Women’s Health has found that the impact of violence against women with serious mental illness has been routinely overlooked in policy development, mental health planning, in clinical practice and educational manuals. Yet, the study argues, an awareness of violence and abuse is critical for understanding mental illness and for assisting women in recovering and maintaining wellness.

The study author, Marina Morrow, a Researcher at the University of British Columbia, notes that despite a growing body of research that illustrates the impact of violence and trauma on women’s mental health, few health programs are designed to meet the needs of women with chronic and persistent mental health problems who have experienced violence. This is especially true for women with diagnoses of borderline personality disorder, women with co-existing substance use and mental illness, women in prison, women with developmental disabilities and Aboriginal, immigrant and refugee populations.

Study participants indicated that many mental health professionals are reluctant to acknowledge the role of violence and trauma in women’s lives, either downplaying its significance, or seeing it as an issue separate from mental health. The result is that current assessment tools and treatment plans do not regularly take violence and trauma into account. These practices severely limit the ability of the mental health system to respond effectively to women and may result in misdiagnoses or lengthy delays in getting women the supports they need.

Mental health providers in the study also indicated that they had very few training and education opportunities on the topic of violence against women, either in their respective professional schools or in their practices. Those programs and opportunities that do exist are not systematically required as criteria of mental health training. Providers specifically identified the need for training which addresses the interconnections between violence, trauma, mental health and substance use.

Background:Increasingly, the prevalence of violence against women and the impact of violence and trauma on women’s physical and mental health have come to be recognized. Canadian statistics suggest that in the general population, 29% of women who are or have been married have been sexually or physically assaulted by their partner. Twenty-one percent of women are assaulted during pregnancy, and in 40% of these cases the abuse first began during pregnancy. Although there is no recent national data on child sexual abuse, in 1984, a Canadian study found that approximately one in two females and one in three males have been victims of unwanted sexual acts. Four out of five of these incidents were committed when the person was a child or a youth.

The prevalence of child sexual abuse appears to be even higher in the population of women psychiatric inpatients. One British Columbia study, which surveyed women at Riverview Psychiatric Hospital, found that 58% had been sexually abused as children. In another study, when both physical and sexual abuse were taken into account, it was found that 83% of women in an inpatient setting had had these experiences. American studies which look at the prevalence of sexual abuse in the lives of women diagnosed with mental illness have found similar rates. Some researchers have found differences in the severity and duration of abuse for clinical versus non-clinical populations, with women in the former category reporting experiences of higher rates of violent abuse of longer duration.

At the most extreme end, violence results in serious physical injury and death. A whole host of other physical health problems have been linked to experiences of abuse and trauma, including central nervous system damage, sleep disorders, migraines, respiratory-related problems, cardiovascular system problems, endocrine problems, gastrointestinal and genito-urinary problems, and reproductive and sexual problems.

Increasingly, however, researchers are attempting to understand the impact of early childhood trauma on mental health. Studies have linked early childhood trauma to depression, borderline personality disorder, multiple personality disorder and substance abuse. Childhood trauma has also been linked to post-traumatic stress disorder.

The health care costs of violence against women in Canada have been estimated at more than $1.5 billion annually. Few studies have assessed the psychiatric health care costs of violence. However, a Canadian study, which focused on the costs associated with the care of 15 female abuse survivors diagnosed with multiple personality disorder, found that the women spent an average of 98.7 months in the Canadian mental health care system before being properly diagnosed, at a lifetime cost of more than $4 million. They estimate that a savings of approximately $85,000 per person could be achieved if earlier and accurate diagnosis were to occur.

Although all women are vulnerable to violence regardless of their race, ethnicity, culture, physical/mental ability, age, sexuality or economic status, the risk and impact associated with violence are compounded if a woman is socially marginalized or living in poverty. Women who have serious mental health problems are particularly at risk because of their illness and their social and living situations. Violence, in this context, is both a feature of women’s histories and a reality of their present-day lives. The particular stigmatization and discrimination that accompanies mental illness makes it especially difficult for this group of women to receive appropriate care and support.

Full study available at the BC Centre of Excellence for Women’s Health, www.bccewh.bc.ca or call: (604) 875-2633.

Assisted Human Reproduction Act approved, at long last

In March 2004, Canada passed the “Assisted Human Reproduction Act”, after more than a decade of debate and revision. The act covers a wide-variety of controversial practices, and prohibits human cloning, sex selection, payment for egg and sperm donors, and payment for surrogacy arrangements.

The Act also ensures the creation of the Assisted Human Reproduction Agency of Canada, a regulatory body that will oversee practices associated with assisted human reproduction, and related research, in order to protect and promote the health and safety of Canadians using AHR technologies.

Now Health Canada has made available a helpful Fact Sheet that explains the details of the Act, and how it will affect inidivudal Canadian women and families seeking fertility assistance.